When the warden of the Southern Ohio Correctional Facility buttons his jacket as he stands over a condemned inmate strapped to the execution table in Ohio’s death house, it’s more than a clothing adjustment.

That simple act is the signal for members of the state’s execution team to start the flow of a lethal three-drug cocktail that will kill the inmate, according to documents turned over earlier this month to defense attorneys challenging the constitutionality of Ohio’s lethal injection process.

Those documents, originally sealed by county Common Pleas Judge James Burge at the request of the state, were released Thursday following a public records request from The Chronicle-Telegram backed by a letter from the newspaper’s attorney challenging the decision to keep the documents secret.

In his order making the documents public, Burge ordered county Prosecutor Dennis Will to redact the names of any execution team member. But otherwise, the 632-page black binder is exactly what experts will review for a hearing Burge plans to hold on whether the state’s current method of executing prisoners is cruel and unusual.

Attorneys for accused killers Ruben Rivera and Ronald McCloud — who could receive death sentences if convicted in two separate Lorain County murders — and other death penalty opponents fear that the drugs used don’t give the quick and painless deaths required by Ohio law.

Who’s on the team?

Among the chief concerns of lethal injection critics is whether the people administering the drugs know what they’re doing.

The state has been reluctant to say anything about who serves on the team, particularly the medical training received by the three members who prepare an inmate’s veins and inject the drugs into long lengths of tubing that snake from a series of five syringes into the inmate’s arms.

At the hearing where the state grudgingly turned over the documents to defense attorneys, Ohio Department of Rehabilitation and Correction Director Terry Collins confirmed that two of the three are trained emergency medical technicians, but he was mum on who the third medical team member was.

While the name has been redacted, the documents show that at least one medical team member is certified by the American Society of Clinical Pathologists’ Board of Registry. That organization handles certifications for numerous jobs in pathology and laboratory work, including hematologists, phlebotomists and those who work in blood banks, according to the society’s Web site.

The team has no fewer than 12 members; the documents say there currently are 16 members of the state’s execution team.

Under Ohio Department of Rehabilitation and Correction guidelines, medical team members are drawn from around the state — sometimes at the recommendation of current execution team members — and must be able, under Ohio law, to administer the intravenous drugs used in the lethal injection process.

Kreig Brusnahan, one of Rivera’s attorneys, said despite the documents, he still questions who’s handling the injections given that no doctors participate in the process — save for the Scioto County coroner, who is on hand only to pronounce the condemned inmate dead.

“We need to do a little further investigation on the qualifications of individuals who are involved in the lethal injection process,” Brusnahan said. “We absolutely have concerns about the individuals who are participating in this process.”

Before they join the execution team, any would-be member must pass a rigorous screening process that includes a review of their record with the prison system, gain the approval of the warden and other prison officials and finally, be confirmed by a vote of the current execution team members, according to the documents.

The team is allowed the final say because “confidentiality and trust are essential elements for the operation of the team,” the documents said.

Members’ training

The team members — three of whom have participated in all 26 executions since Ohio resumed executing death row inmates in 1999 — undergo training at least four times a year, according to the documents. And in the month leading up to the execution, team members practice once a week for four weeks, including preparing to handle inmates who physically resist.

In one document dealing with “volunteer” inmate Darrell Ferguson, who was executed Aug. 8, 2006, for a 2001 triple murder in Montgomery County, the team planned for how to deal with the “worst-case scenario” if Ferguson changed his mind after the first drug, a sedative, had begun to put him to sleep and what they would do to save his life.

In addition to regular and pre-execution training, medical personnel on the execution team must keep their certifications on injecting intravenous drugs current. The documents turned over by the state reveal several booklets on administering drugs — including finding suitable veins — and how to handle the equipment used in the process.

Members practice their injection skills using an artificial arm, which they inject with water.

Some of the manuals in the documents are written by and for nurses, including one which advises, in the event of a blocked line, that a nurse who can’t fix the problem themselves should “call your surgeon and beg forgiveness.”

The drugs flow

The lethal injection process doesn’t always go smoothly as evidenced by the May 2, 2006, execution of Joseph Clark for a 1984 murder in Lucas County.

The medical team had difficulty fitting shunts for the drugs into the arms of Clark, a former intravenous drug user, eventually settling on one shunt instead of the normal two. When that line “blew” and became unusable, the medical team had to enter the death chamber and establish another line. Clark’s entire execution ran about 90 minutes instead of the typical 30 minutes, the documents said.

That prompted several changes in the lethal injection process after a review ordered by former Ohio Gov. Bob Taft. The changes included requiring three examinations of the condemned inmate and his veins. Prior to Clark, the vein examination was conducted during a medical checkup prior to the execution without the inmate’s knowledge.

The state also added a low-pressure drip of saline solution that flows through the tubing and into the inmate to make certain that the shunts remain usable prior to the fatal drugs being administered.

Additionally, the state also sought to eliminate an “artificial self-imposed time barrier resulting in enormous pressure on execution team members,” according to the documents.

When a death warrant is issued in Ohio, it’s good for 24 hours. But because executions are scheduled for 10 a.m. on Tuesdays, the team was rushing to carry them out, instead of taking its time and making sure the process was carried out properly, the report concluded.

But even those changes didn’t prevent a problem from arising during the May 24 execution of Christopher Newton for a 2001 murder in Richland County. It took the execution team around 90 minutes to find Newton’s veins and nearly 15 minutes for the drugs to kill him.

When James Filiaggi of Lorain County was executed a month before for the 1994 shooting death of his ex-wife, Lisa Filiaggi, it took nine minutes from the time the drugs started flowing until he was pronounced dead.

The problem

Critics of the process say that it’s impossible to know whether Filiaggi or Newton suffered.

The first drugs that enter the condemned’s system is a sedative that effectively puts him to sleep. The second drug induces paralysis, including in the lungs. The final drug induces a heart attack.

If the sedative wears off before the inmate dies, Brusnahan said, the dying prisoner would suffer horribly.

“The problem we have is if an individual is paralyzed, they can’t express anything because they’re paralyzed, so we don’t knowwhether the (later drugs) cause pain,” he said.

The documents provided by the state don’t have all the answers, Brusnahan said.

It’s still unclear, for instance, exactly what the length of the tubing that runs from the syringes to the inmate’s arms is. That could prove to be crucial information, Brusnahan said, for determining whether there’s a kink in the line and how long it takes the drugs to reach the inmate.

It’s going to take time, Brusnahan said, for the experts for both the state — which continues to insist that its lethal injection process is a humane and constitutional method of execution — and Rivera and McCloud and their attorneys to work their way through the documents.

In the meantime, the U.S. Supreme Court plans to examine whether the lethal injection process used in Kentucky is constitutional.

Because virtually every state uses an almost identical process to execute condemned inmates, there’s effectively a moratorium on carrying out death sentences in the United States — for now.